Peroneal Nerve Repair with Cross-Bridge Ladder Technique: Parallel End-to-Side Neurorrhaphies.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Regenerative Medicine

Background:

• Nerve injuries often necessitate nerve transfer techniques when primary repair is not possible.
• Common techniques include end-to-end, end-to-side, and side-to-side neurorrhaphy.
• The cross-bridge ladder technique, while promising in animal models, is underutilized clinically.

Purpose of the Study:

• To explore the clinical utility and outcomes of the cross-bridge ladder (H-shaped) nerve repair technique.
• To evaluate its effectiveness in patients with persistent foot drop due to nerve injury.

Main Methods:

• Four patients with severe foot drop (MRC grade 0) underwent evaluation, including electrodiagnostic studies.
• A cross-bridge ladder repair was performed using tibial nerve to common peroneal nerve grafts with end-to-side neurorrhaphies.
• Ankle dorsiflexion strength was assessed using the Medical Research Council (MRC) grading system preoperatively and postoperatively.

Main Results:

• All patients had persistent foot drop (MRC 0) for 6-15 months post-trauma.
• Three patients improved to MRC grade 2 within months.
• One patient achieved MRC grade 2 by 1 month and full recovery within 4 months.

Conclusions:

• The cross-bridge ladder technique is clinically useful for persistent foot drop following trauma.
• The technique facilitated motor function recovery in all patients, with both early and late improvements observed.
• Continued functional improvement was noted in some patients up to the final follow-up.